The Modern Treatment of the Menopause and Breast Cancer

The duration of menopausal symptoms can last 10 or more years with hot flashes, night sweats, flushing, anxiety, sleep disruption, and heart palpitations. Over the long term estrogen and testosterone deficiency also leads to vulvovaginal atrophy (VVA), causing atrophy of the vulva, vagina and lower urinary tract. Over the years symptoms of menopause eventually resolve, however the physical changes of VVA are progressive and continue to adversely affect health, sexuality, and the quality of life. The vagina narrows and the introitus contracts. The vaginal surfaces becomes thin, dry, and sensitive. Urinary urgency and incontinence are often a result of loss of normal hormonal support of the urinary tract.

Hormone replacement is the best treatment for menopausal symptoms and VVA but the Women’s Health Initiative started in 1991 associated an increased incidence of breast cancer with the oral hormone replacement PremPro (estrogen and medroxyprogesterone), placing post-menopausal women in a quandary – risk breast cancer or enjoy a normal premenopausal lifestyle. The media and many physicians assumed this study included ALL hormones, but the only hormone replacements studied were the oral medications PremPro and Premarin (estrogen only). The study actually found that oral estrogen alone didn’t cause any increased risk for breast cancer. These same studies indicated that estrogen alone may even reduce risk for breast cancer. The media didn’t bother to differentiate PremPro from Premarin leaving many women and physicians thinking all hormone therapy caused cancer. The WHI published results can be found at https://www.nhlbi.nih.gov/whi/whi_faq.htm.

A brief summary of the WHI findings on estrogen plus progesterone and estrogen only:

Compared with the placebo, estrogen plus progestin resulted in:

Increased risk of heart attack

Increased risk of stroke

Increased risk of blood clots

Increased risk of breast cancer

Reduced risk of colorectal cancer

Fewer fractures

No protection against mild cognitive impairment and increased risk of dementia (study included only women 65 and older)

Compared with the placebo, estrogen alone resulted in:

No difference in risk for heart attack

Increased risk of stroke

Increased risk of blood clots

Uncertain effect for breast cancer

No difference in risk for colorectal cancer

Reduced risk of fracture

Clearly the use of oral hormones with or without progesterone is not advisable. The life time incidence of breast cancer increased 5% and stroke and blood clots increased for those using oral PremPro (estrogen and medroxyprogesterone) and Premarin based on WHI data.

Breast cancer risk is influenced by many factors. Estrogen with Progesterone is not the only contributor to increased breast cancer risk, it is actually a minor contributor. Compared to women who don't drink at all, women who have three alcoholic drinks per week have a 15% higher risk of breast cancer. Experts estimate that the risk of breast cancer goes up another 10% for each additional drink women regularly have each day. For women who have never had breast cancer, a daily glass of wine increases breast cancer risk by 55% and the risk for dying from breast cancer by 20%. These numbers are from studies published in the November 2011 issue of the American Journal of Epidemiology (http://aje.oxfordjournals.org/content/174/9/1044.full.pdf+html) that looked at more than 320,000 people and the November 2, 2011 issue of the Journal of the American Medical Association (http://jama.jamanetwork.com/article.aspx?articleid=1104569) that looked at more than 105,000 women enrolled in the Nurses’ Health Study. Regular drinking — even as little as two or three drinks a week — raises breast cancer risk significantly more than that of PremPro.

Any increased risk for breast cancer is not acceptable. Menopausal symptoms can be treated and breast cancer risk can be reduced with the proper hormone balance and minor life style changes. Recent research has shown that the use of estrogen and testosterone does not increase, but may decrease the incidence of breast cancer. The use of hormone replacement, estrogen only and that including testosterone has been shown to reduce the risk of breast cancer in a number of studies done over the past 10 years, a few of which I have included here. The use of progesterone, which is the hormone most associated with increased breast cancer risk should be minimized and used only as needed to decrease the incidence of endometrial (uterine) overstimulation and vaginal bleeding.

Finally, the risk of breast cancer is decreased with a diet high in or supplemented with folate. The risk of breast cancer is significantly increased with alcohol intake. This increase may be reduced with folate supplementation.

2. Research in 2005 showed no clear support for an overall relationship between folate intake or blood folate levels and breast cancer risk was found. Adequate folate intake may reduce the increased risk of breast cancer that has been associated with moderate or high alcohol consumption. http://jnci.oxfordjournals.org/content/99/1/64.abstract

3. Research in 2014 showed that folate may have preventive effects against breast cancer risk, especially for those with higher alcohol consumption level; however, the dose and timing are critical and more studies are warranted to further elucidate the questions. http://www.nature.com/bjc/journal/v110/n9/full/bjc2014155a.html

In summary a balance between estrogen, testosterone, and progesterone can safely be used to treat menopausal symptoms and avoid the life style changes associated with VVA. Furthermore significant reduction in breast cancer risk can be achieved by adding testosterone to usual hormone replacement, limiting alcohol intake, and having adequate folate levels either by supplement or by diet.

Doing your Labs with DFW Hormones cost substantially less than other Providers and results are interpreted quickly and in understandable terms.

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The information contained on this site is intended strictly for research and informational purposes only. It does not, in any way, establish a provider/patient relationship with any individual and does not constitute medical advice, directives, or care. You should speak with your personal health care provider before making any changes in your medical treatment and follow their instructions for care. The information provided is publicly available and cannot be considered complete nor is it intended to diagnose, or direct treatment for, any medical condition. The content must not be used to substitute a medical exam, and/or management of any health issue by a qualified medical provider.